Archives for category: HEALTH

WHY WOMEN ARE LESS LIKELY TO BE DIAGNOSED FOR SLEEP APNEA

By Charles Kravitz, DDS in Women’s Health
Swedish scientist Dr. Karl Franklin and his team set out to find out how prevalent sleep apnea is among women and how often symptoms occur. Out of a population-based random sample of 10,000 women between the ages of 20 and 70 years, they gathered data on 400 of them. The test group were given questionnaires which included several questions regarding their sleeping habits and sleep quality. They also underwent overnight polysomnography.

WOMEN ARE LESS LIKELY TO BE DIAGNOSED FOR SLEEP APNEA

Women with sleep apnea are less likely to be diagnosed compared to men. In studies of patients registering for evaluation for sleep apnea, the ratio of men to women has sometimes been extremely lopsided, with 8 or 9 men diagnosed with obstructive sleep apnea (OSA) for each woman found to have OSA. However, we know from studies in the general population that the actual ratio is likely to be closer to 2 or 3 men with OSA for each woman who has the condition.  Women make up about 45 percent of sleep study referrals and most sleep studies are still done to screen for sleep apnea.

WHY ARE WOMEN LESS LIKELY TO BE DIAGNOSED FOR SLEEP APNEA?

 First, there is an unfortunate predefined notion of the make-up of a sleep apnea patient. The stereotype is a middle-age, overweight or obese male. Physicians may not be thinking of this OSA diagnosis when the patient is female. Second, women may present with slightly different symptoms than the “classic” symptoms of snoring, witnessed breathing pauses at night and excessive sleepiness during the day.

Instead, women may present with fatigue, insomnia, disrupted sleep, chronic fatigue and depression morning headaches, mood disturbances or other symptoms that may suggest reasons other than OSA for their symptoms. Because these symptoms are not specific for OSA, women may be misdiagnosed and are less likely to be referred to a sleep study for further evaluation. Another problem is that women with sleep apnea have more subtle breathing disturbances and are more likely to have REM-related apneas, so they may be tougher to diagnose.

COMMON SLEEP APNEA MISDIAGNOSES
Women are often diagnosed in error with one of the following conditions, rather than sleep apnea.
  • Anemia
  • Cardiac or pulmonary illnesses
  • Depression
  • Diabetes
  • Fatigue from overwork
  • Fibromyalgia
  • Hypertension
  • Hypochondria
  • Hypothyroidism
  • Insomnia
  • Menopausal changes
  • Obesity

Sources

Dr. Karl Franklin, European Respiratory Journal

Grace W. Pien MD, MS, assistant professor of medicine, divisions of Sleep Medicine and Pulmonary and Critical Care at the University of Pennsylvania School of Medicine.

Nancy A. Collop , MD, medical director at Johns Hopkins Hospital Sleep Disorders Center and associate professor of medicine atHopkins’ Division of Pulmonary and Critical Care Medicine in Baltimore, Md .

Fiona C. Baker, PhD, sleep physiologist, Center for Health Sciences, SRI International, in Menlo Park, Calif.

Anita L. Blosser, MD, with Duke Primary Care at the Henderson Family Medicine Clinic in Henderson, N.C.

HOW SLEEP APNEA INFLUENCES SYSTEMIC DISORDERS AND HOW YOU CORRECT THEM
The article on women with sleep apnea raised so much interest that I am offering a follow-up with some explanations you asked for.
So, you are a woman in dentistry, caring and dedicated. You want to give your obstructive sleep apnea (OSA) afflicted patient a simple layman explanation on the importance of healthy sleep.

Try this:

1.  The key is oxygen.

Can you imagine holding your breath for 10 seconds and even up to a minute, 20 times per hour on average, when you thought you were sleeping? That’s Moderate (not Severe) sleep apnea. That’s 160 apnea events X 10 seconds  = 1600 seconds (27 minutes during an 8 hour “sleep” session. And it could be much higher.
How much oxygen would pass to your lungs and consequently to all your organs during that time? Every system in your body will suffer and break down. And that would lead to strokes among other repercussions.
2.  Why high blood pressure and acid reflux (GERD) are common co-morbidities of OSA
During the cessations of breathing the body will increase its efforts to take in air.
Abdominal contractions are exaggerated and increase until breathing resumes.  The contractions squeeze the stomach and force acid through the LES and up the esophagus.
The efforts to breathe also increase a negative pressure in the esophagus which also pull up acid and elevate blood pressure. Aha! The mystery is resolved!
3. The solution.
 Correct the sleep breathing disorder (Oral Appliance Therapy ((OAT) is effective, economical and convenient), and you will observe the symptoms of OSA diminish and in many cases disappear. Isn’t hat a lot better than popping pills every day.?
Studies show that people suffering from sleep-disordered breathing have an increased risk of developing cancer and are up to five times more likely to die from the disease.   Once again the culprit is HYPOXIA. The lack of oxygen (hypoxia) caused by untreated Obstructive Sleep Apnea (OSA) can be a catalyst for a process called neovascularization (the creation of new blood vessels), giving a blood supply that can encourage tumor growth.  Snoring may be a warning that you may have OSA.

Cancer cells thrive in a low oxygen environment. Hospitals will put a patient on oxygen if their O2 levels drop below 92. Untreated OSA can cause oxygen levels to drop anywhere from the 90’s, 80’s and even in the 50’s.

Sleep apnea causes sustained low blood oxygen.

One of the biggest problems with sleep apnea is the way in which it deprives the body of necessary oxygen. Frequent apneas (pauses in breathing that last at least 10 seconds, but often last much longer) lead to nocturnal intermittent hypoxia.

Dentists perform exams of  patient’s mouth, neck, and airway on a regular basis while screening for oral cancer. These health screenings are important, lifesaving moments in a patient’s health journey– we can do that with a similarly deadly condition like untreated sleep apnea.

Detecting OSA and leading the way for treatment can add YEARS to a  patient’s lifespan while significantly improving quality of life. Both cancer and OSA have symptoms that can be easily recognized in the chair during a regular checkup. While checking the mouth for masses and swelling, you can also check on the Mallampati score  and be alert to possible concerns you may have.

 

MALLAMPATI EXAM

Symptoms of both oral cancer and sleep apnea should be screened for everyone, especially for heavy drinkers and tobacco users. The irritation from cigarettes and other forms of tobacco may cause inflammation that’s disruptive to the airway. Smoking, of course, is known for its carcinogenic properties, but perhaps more surprising is that around 70% people diagnosed with oral cancer turn out to be heavy drinkers. Alcohol use is also known to cause apneic events by relaxing muscles in the airway (this is particularly dangerous when people use alcohol to help get to sleep due to an already existing issue with sleep apnea).

WOMEN WITH SLEEP APNEA HAVE INCREASED RISK OF CANCER 

We know that men are more at risk of developing sleep apnea. But if you happen to be a woman and you suffer from OSA your risk of developing cancer is more than your male counterparts, says a recent research published in the European Respiratory Journal. During the study the scientists collected data of 20,000 patients with OSA. It was found that around 2 per cent of these patients were later diagnosed with cancer.

Researchers analysed data based on age, gender, alcohol consumption, body mass index and smoking. Again, there was a strong association between sleep apnea and higher cancer prevalence. Additionally, the link was stronger in women than men.

A 2012 study identified a link between sleep and aggressive breast cancers. Ref: American Cancer Society

MORE CASE STUDIES

In 2013, Spanish researchers reported that people with severe sleep apnea had a 65 percent increased risk for cancer. They suggested the risk is associated with increased hypoxia, a condition where the body is deprived of oxygen.

Another study from the University of Wisconsin found people with sleep-disordered breathing are five times more likely to die from cancer than people without sleep apnea. Researchers from the American study admit the study is limited in that there are no studies to compare it with that look at cancer survival in people with sleep apnea.

One recent study reported in the Journal of Sleep Medicine shows moderate and severe cases of sleep apnea are associated with increased cancer risk. That study also showed an increased risk for all “all-cause mortality” and cancer mortality due to cancer. The 20-year study showed that people with moderate to severe cases of sleep apnea are two and a half times more likely to develop cancer and three times more likely to die from cancer. The authors noted these findings confirmed previous research conducted by American and Spanish researchers.

Animal studies have also confirmed previous findings. One 2014 study  reported in the journal Cancer Research linked sleep apnea with aggressive cancer growth in mouse models. Mice with tumors were placed in low oxygen environments that mimic the effects of sleep apnea and tumor growth in the mice progressed rapidly.

 

With a convincing condemnation of Sleep Apnea as a cause of cancer we need to be more serious about screening patients for cancer and OSA.

 If you have any concern about your risk, ask us about it.  We’re here to help.

A dentist asked me, “ How do I find sleep apnea patients that I can treat?“

Here’s how I answered him, “They will find you.“
If you saw the award winning movie “Field of Dreams” you will remember Ray Kinsella (Kevin Costner) being told, “Build a field and they will come.”   He did build a baseball field in a Kansas corn field and sure enough the great legends of the game came to play there.
After you have been trained and become confident in your screening and treatment skills you’ll be pleasantly surprised at the vast number of sleep apnea patient resources.  Build your field and they will come.
These are just a few of the sources available to you:
  • word gets around that you are the sleep doctor and new patients will seek you out
  • your patient base will produce enough candidates to keep your schedule filled  
  • you will be developing a network of healthcare professionals that will send you patients
  • patients you have treated will be referring their family and friends
Success in Dental Sleep Medicine, unlike in other ventures, does not have to be long and drawn out. If you focus on all the “little things“ and stay dedicated you will reach your objective in a few months.
Studies reveal OSA is prevalent. 
-A 2015 study in Switzerland reported 50% of men and 23% of women had at least moderate OSA.1
-In 2002, the Sleep Heart Health study found that 24% of men and 9% of women have at least mild OSA.2

-In the Wisconsin Sleep Study Cohort, it was reported that 10% of men and 3% of women age 30 to 49 have at least moderate OSA, while 17% of men and 9% of women age 50 to 70 have at least moderate OSA.

-Over 50% of children diagnosed with ADHD suffer from sleep apnea
-According to a Harvard health report there are 18.9 million undiagnosed cases of obstructive sleep apnea and 40% (1.3 million) of CPAP users are non-compliant. So that alone conservatively projects 20.2 million victims of obstructive sleep apnea who may be helped by a dentist trained in Oral Appliance Therapy (OAT). 
-OSA is highly underrecognized, and it is estimated that 82% of men and 93% of women in the United States with OSA are undiagnosed.4
Is there any better opportunity today in dentistry?
Are you ready to build your field of dreams?
Write me with any questions at cskdoc@aol.com.
References
  1. Heinzer R, Vat S, Marques-Vidal P, et al. Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study. Lancet Respir Med. 2015;3(4):310-318.
  2. Young T, Shahar E, Nieto FJ, et al; for the Sleep Heart Health Study Research Group. Predictors of sleep-disordered breathing in community-dwelling adults. Arch Intern Med. 2002;162(8):893-900.
  3. Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177(9):1006-1014.
  4. Young T, Evans L, Finn L, Palta M. Estimation of clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep. 1997;20(9):705-706.

                                                                                     

                                                                                          ‘it’s THE START that STOPS most People’

We know you are interested in developing a strong presence in the exciting and profitable world of Dental Sleep Medicine.    Here are answers to the most frequently asked questions.
  1. “Are there enough patients who need my DSM Service?”

If  you did not get one new patient coming to your office because of your new magnet (DSM) you could keep a schedule filled with your existing patients. Studies show that 34 percent of the American public have symptoms of sleep disorder. That means that one of every three people that you currently treat (IN ADDITION TO those new patients that hear about you), are there for you to help.

According to a Harvard health report there are 18.9 million undiagnosed cases of obstructive sleep apnea and 40% (1.3 million) of CPAP users are non-compliant. So that alone conservatively projects 20.2 million victims of obstructive sleep apnea who may be helped by a dentist trained in Oral Appliance Therapy (OAT). Is there any better opportunity today in dentistry?

  1. “Why is THIS the best time for me to learn DSM?

Dental Sleep Medicine is the hottest button in dentistry today.
Awareness of sleep apnea in America is at an all-time peak. The fires of awareness are being stoked by the public media and by social media. Patients are understanding and becoming increasingly more concerned about the blockage of oxygen to the brain and to other organs. Strokes. Heart attacks. Diabetes. Dementia. People are recognizing that they have the symptoms and are asking their Dentists about it. Some Dentists have the solutions. Every Dentist would like to be “The Sleep Dentist.

  1. “How would I get paid? Do Insurances cover the Services?”

With training in Dental Sleep Medicine you will learn the answers to these often asked questions about reimbursement:

-What is the difference between dental and medical codes?
-What is Durable Medical Equipment and how does that apply to us, as dentists?
-How some dentists leave thousands of dollars of medical reimbursement on the table and lose case acceptance in the process    -What  are the deductibles?
-What documents do I need for successful medical insurance processing?
-What do I need to know about Medicare?

-The number one medical billing error you should not make

 4.  “How do I get Started?”

If you are interested enough to have read this far, you have already started. To succeed in DSM you must have passion for helping people and excitement for being at the forefront of a new medical/dental science. With only 4% of dental practices qualified to offer these services, you can be proud to be a medical/dental pioneer.

The first step in your education is to attend a DSM training seminar. There you will learn all the basics. Sleep Group Solutions presents two-day seminars every weekend in two different cities. The “Introduction to Dental Sleep Medicine” covers all aspects “from A to Pay”. You will learn the mysteries of the science of sleep, a functional protocol for screening and treating patients, how to find patients who need your services, the various intra-oral appliances and how to monitor their efficacy. and billing benefits with medical codes.

Oral appliance therapy (OAT) is the most convenient and preferred therapy for the mild and moderate cases and for those patients who cannot tolerate the CPAP device. Fortunately, this is where The Dentist rides in on a white horse to the rescue. We dentists like to say we are on the front line of the battle against sleep apnea. Dentists are in the optimum position to see the signs and symptoms and can offer the most preferred solutions to the problem..
In the words of the Great Master Yoda, in the classic Star Wars movies, “There is no ‘try’; there is only ‘do’ or ‘do not’.”

                                                                                                                                                                                     “It’s the Start that Stops Most People”

MALLAMPATI EXAM

Are you concerned about Obstructive Sleep Apnea?  You should be because it is estimated that 22 million Americans suffer from sleep apnea, with 80 percent of the cases of moderate and severe obstructive sleep apnea undiagnosed.
 

Here is a simple yet accurate diagnostic test you can use to see the opening of your airway.

Stand in front of a mirror and protrude your tongue. Aim a light toward the back of your mouth.
Is your airway open like the diagram on the left? You are safe.
SIZE DOES MATTER
If your airway is obstructed by the base of your tongue, or a droopy soft palate, or from side to side by the pillars or tonsils, then this should concern you.
WHAT IS OBSTRUCTIVE SLEEP APNEA?
Obstructive Sleep Apnea (apnea=without breath) occurs while you are at sleep and not even aware of it. (Your bed partner may be well aware of your symptoms.)  During an apnea event you will not be able to inhale for 10 seconds and even up to a full minute until your body forces an autonomic response: your tongue will push forward in an attempt to open the airway, your teeth will gnash and grind.  When you are awake you may be able to see these signs in your mouth but you are unaware while asleep.
This dangerous cycle may repeat throughout your night and it may average 30 such episodes per hour. A severe case of obstructive sleep apnea (OSA) could produce 240 episodes during an eight hour sleep. This is not uncommon.
Imagine how much life-supporting oxygen is being transported to your heart, your brain, and other organs. Well-known mental effects of OSA are chronic daytime fatigue, irritability, confusion, inability to concentrate, dementia, and Alzheimer’s disease.
High blood pressure, strokes, heart attacks are also connected to OSA.
FOR DENTISTS:
If you want to learn about the treatment protocol, case planning, insurance coverage, and the rewards, I strongly recommend this 2 day, 16 CEU course for dentists and hygienists. Dates and cities here:        http://join.sleepgroupsolutions.com/seminars/
By registering with this promo code CK200 you will save $200 off the cost of the tuition and bring a hygienist tuition-free,  In this website you’ll see the cities and dates for this training course.
Add a valuable service to your resume’ free of charge.
You will receive the same benefits as your dentist including 16 CE units.
Help your doctor treat patients that have Obstructive Sleep Apnea.

MALLAMPATI EXAM

Why You will want to do this:

-Free attendance at this important training seminar.
Learn how to screen and treat Obstructive Sleep Apnea (OSA)
-16 CEUs -FREE
-Have a key role in your practice as a sleep coordinator. 
-Increased value to your practice
-Potential of greater income for you
-A more relaxed patient service
-Admiration by your peers for your leadership.
-Respect from your patients for helping them with a needed medical service.
-The great feeling of knowing that you are truly saving lives.

 


This offer is valid only through August 31, 2019.

Eligible Dental Assistants may also qualify.

Email or IM me for a list of locations and dates of this tuition-free course.  Cskdoc@aol.com
 
Charles Kravitz, DDS
Professional Relations Director
Sleep Group Solutions

WHAT IS MISSING IN YOUR COMPREHENSIVE DENTAL EXAM?

A truly professional comprehensive dental exam examination (D0150 or D0180) should include much more than what the CDT codes delineate.
What is essential?
Beyond the obvious FMX, charting of existing and needed dental and periodontal conditions, and an oral cancer screening, there are many other evaluations which are directly related to our services and are within our authority and responsibility.
The Comprehensive Exam should also include measurement of vitals such as blood pressure, etc. and a sleep dysfunction screening with a sleep questionnaire and a careful discussion of any notable items (alerts) in the patient’s med and sleep history. These things don’t need to be spelled out in the CDT code. They come with our desire to do what we know is right.

MALLAMPATI EXAM

TMJ exam, facial muscle palpation, Mallampati classification  (correlates tongue size to pharyngeal size) and an oxygen saturation test will provide critical information.  Any dentist/hygienist/team will chose how extensive they wish their dental exams to be and what should be included.

Would we be “spending too much time” in a dental exam visit?

Not if we care about our patient’s total well being, our conscience, and our dental license.

And is this “nearly always accepted by patients with huge value and appreciation”? YES, it is when the dental team shows their patients how much passion, care and skill they have. I see it in many dental offices. The really successful ones.

5-20-12 HUMAN PYR

Do you want to do more?
Here’s your opportunity to increase your service to your community, to create your “niche”, and  to stand out in your community as a complete care-giver. Your rewards will be enormous!
It is reported that 34% of the population has sleep breathing symptoms. One of the next three patients that walk thru your doors is your candidate.

Are you able to help them?

Does your New Patient Exam include a screening for Sleep Apnea?1-21-13 LOGO DENTAL PROS SHARING

 

Interested? Then check this out: http://sleepgroupsolutions.com

or ask me:  cskdoc@aol.com

Getting tired of the nasty weather, yet?

Come down to sunny, warm Florida and escape the mean cold winter while learning a valuable service to help your patients.

Dr. John Carollo presents his Dental Sleep Medicine seminar in Jacksonville and offers you 16 CE credits.

DATE/TIME
April (04/05/2019 – 04/06/2019)
8:00 am – 5:00 pm

 

LOCATION
DPC Technology
7845 Baymeadows Way Suite A
Jacksonville, FL, 32256

Phone: 904) 443-0095 (for hotel reservations only)

While your family is running around spending your money in Florida you will be learning a valuable new dental service. But let them spend because when you get back home you’ll quickly recover your total weekend costs as a Sleep Medicine Dentist.

Sleep Apnea victims are looking for a dental professional like you to treat their symptoms. One of every three patients that walk through your door has a sleep breathing dysfunction. Your patients need your help

See the course content and register here: https://join.sleepgroupsolutions.com/seminars/jacksonville-fl-3/#axzz5gnE9eOJY

Getting tired of the nasty weather, yet?

Come down to sunny, warm Florida and escape the mean cold winter while learning a valuable service to help your patients.

Dr.John Carollo presents his Dental Sleep Medicine seminar in Jacksonville and offers you 16 CE credits.

DATE/TIME
April (04/05/2019 – 04/06/2019)
8:00 am – 5:00 pm

LOCATION
DPC Technology
7845 Baymeadows Way Suite A
Jacksonville, FL, 32256

Phone: 904) 443-0095 (for hotel reservations only)

While your family is running around spending your money in Florida you will be learning a valuable new dental service. But let them spend because when you get back home you’ll quickly recover your total weekend costs as a Sleep Medicine Dentist.

Sleep Apnea victims are looking for a dental professional like you to treat their symptoms. One of every three patients that walk through your door has a sleep breathing dysfunction. Your patients need your help

Review the course outline and register here:

https://join.sleepgroupsolutions.com/seminars/jacksonville-fl-3/#axzz5ggwYeUFQ
04/05/2019 – 04/06/2019
Dr. John Carollo
JACKSONVILLE, FL

DPC Technology